False Claims Act/Qui Tam

This blog is about qui tam, a  lawsuit brought under the False Claims Act by a private plaintiff on behalf of the Federal or State Government (rather than by the Government itself). The False Claims Act was originally enacted by Congress in 1863, as a response to widespread abuses by government contractors against the Union Army during the Civil War. The qui tam provisions are now used widely and this blog is intended to keep readers up to date with all qui tam related news and to provide commentary when warranted.  This blog also contains an array of laws and regulations concerning qui tam set out in an easy to read format.

Posts tagged as:

Medicare

New York City Home Health Agencies Pay $24 Million to Settle False Claims Act Claims

by Nolan and Auerbach on December 17, 2009

The United States Department of Justice announced December 17, 2009 that the U.S. and state of New York have entered into settlement agreements with three home health agencies to resolve allegations that they submitted false claims to the New York Medicaid and Medicare programs.

The U.S. contends that Nursing Personnel Home Care knowingly supplied aides with phony training certificates to Extended Home Care and Excellent Home Care, which then billed New York Medicaid for the aides’ services. Allegedly, Extended Home Care and Excellent Home Care knowingly billed for aides with phony certificates who were untrained, and Extended Home Care and Excellent Home Care knowingly submitted claims to the Medicare program for home health aide services purportedly rendered by aides supplied by Nursing Personnel Home Care that were not actually provided.

The U.S. is receiving about $9.7 million as a result of the settlement with these three companies, and the state of New York is receiving about $14.3 million, for a total recovery of $24 million.

The allegations resolved by these settlements were initiated by two lawsuits filed under the whistleblower provisions of the False Claims Act.

For the full press release, go to: http://www.justice.gov/opa/pr/2009/December/09-civ-1362.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA. 

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Iowa Hospital to Pay U.S. $4.5 Million to Resolve False Claims Act Allegations

by Nolan and Auerbach on August 31, 2009

Covenant Medical Center in Waterloo, Iowa has agreed to pay the United States $4.5 million to resolve allegations that it violated the False Claims Act, the Department of Justice announced today.

This settlement resolves allegations that Covenant submitted false claims to Medicare by having financial relationships with five physicians that violated the Stark Law. The United States alleged that Covenant violated the Stark Law by paying commercially unreasonable compensation, far above fair market value, to five employed physicians who referred their patients to Covenant for treatment. These physicians were among the highest paid hospital-employed physicians not just in Iowa, but in the entire United States, according to the DOJ.

For the full press release, go to: http://www.usdoj.gov/opa/pr/2009/August/09-civ-849.html.

For more information about qui tam law and health care fraud, contact Nolan and Auerbach, PA .

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Dallas Hospital Reaches Settlement With the Government for Stark Violations

by Nolan and Auerbach on January 2, 2008

According to the U.S. Attorney Richard B. Roper of the Northern District of Texas, Harris Methodist HEB Hospital, a 284 bed acute-care facility, will pay $1.9 million to settle allegations that it violated the False Claims Act by improperly submitting claims for payment for orthopedic-related items and services.  These claims were identified as having taken place between March 15, 2004 and September 1, 2005.

According to the hospital in its own news release, the parent company of Harris Methodist HEB Hospital (Texas Health Resources) did a self report by telling the Office of Inspector General of Health and Human Services about it identification of a physician contract that did not comply with federal regulations. This triggered an investigation based on information provided by Harris Methodist HEB that Medicare and Texas Medicaid programs paid for orthopedic items and services referred to the hospital by a physician group that received free rent from the hospital, a violation of Stark self-referral law (also known as Physician Self-Referral Law).

The Stark law was created to forbid physicians from profiting from their own referrals.  This law acts to sanction improper physician referrals and to stop the potential for over-utilization. In this fashion, physicians and other health care professionals are able to exercise independent judgment for what is in the best interests of their patients as opposed to themselves.

To read the full story click here or on the following to read more about the False Claims Act and the Stark Laws .

If you believe you have information concerning a violation of the False Claims Act and want to read more about Nolan & Auerbach, P.A. you may contact us.

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Hospitals Are Giving Lessons on Blowing the Whistle on Fraud

by Nolan and Auerbach on December 27, 2007

A federal law that takes effect in January 2007 requires the country’s hospitals and nursing homes to educate their employees and officers on how to detect and report fraud. This requirement applies to companies that earn at least $5 million a year in Medicaid business. Under the False Claims Act, whistleblowers have received millions of dollars for disclosing large-scale fraud.

To read more, click here.

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